Eric Mauri Michael Marquis Matthew Kasztejna Advised by: Dr. Wes Ely Delirium Detection Eric Mauri Michael Marquis Matthew Kasztejna Advised by: Dr. Wes Ely

Delirium Overview Brain’s form of organ dysfunction Defined as a disturbance of consciousness characterized by an acute onset and fluctuating course of impaired cognitive functioning. Develops in over 80% of ICU patients Direct consequence of medical conditions, medication, toxin exposure, or a combination of all of these.

Delirium Demographics Occurs in 15-60% of general patients and most frequent complication of hospitalization in older patients Complicates 2-3 million people yearly. Involves over 17.5 million inpatient days. Over $4 billion in Medicare expenditures. Development of delirium selected as one of the top three most important areas for quality of care improvement in older adults.

How is it detected? Arousal and Attention Assessment Problems Confusion Assessment Method (CAM) Acute onset of mental changes Inattention Disorganized thinking Alertness Problems Subjective No Standardization Time Intensive

Project Objectives Develop system that can continuously measure delirium in ICU patients Device must be small, cost-effective, comfortable, and practical Real-Time measurements, data storage, and analysis of information (software)

Proposed Solution Quantitative EEG Benefits Acquire digital signal Transform it into the frequency domain Focus on certain frequency bands that have been clinically shown to be important to sleep. Benefits Inexpensive Noninvasive Software reduces man hours Most importantly several studies have shown that EEG can be effectively used to monitor sleep

Possible Systems Gold Standard EEG – Sleep Labs Bispectral Index (BIS) – Aspect Medical Sleep I/T Vitaport - Temec

Ruled out systems Gold standard EEG BIS Most complex The 26 lead system is too complicated for use in the ICU. BIS Simplest Derived from measurements of frequency, amplitude and coherence of EEG. 3 lead system which produces a single number to describe changes in EEG that relate to levels of sedation and consciousness.

BIS Problems Studies have shown that BIS is only effective for the first 3 stages of sleep. During sleep the BIS number decreases as sleep progress from the first to third stage, however the number increases during REM sleep due to increased glucose metabolism in the brain. Modified system would be too experimental for Dr. Ely’s work.

Remaining Possible Systems Sleep I/T and Vitaport Both systems are full clinical Polysomnographs (EEG, EOG, EMG, EKG, respiratory effort, oxygen saturation) While currently too complex for ICU, the potential for simplification exists. Dr. Ely prefers focus on Vitaport because it is seems to be best combination of (1) a validated sleep monitoring system and (2) a viable and practical method for use in ICU patients

Current Work Educating ourselves about the Vitaport system and its features. Currently in contact with Temec about obtaining a Vitaport system for experimentation. Determining design changes to Vitaport as dictated by ICU environment. Discussing possible modifications and requirements with Dr. Ely

Future Work Continue working with Dr. Weinhouse and engineers at Temec. After acquiring Vitaport system make necessary modifications. Using the modified system collect actual data on ourselves and determine accuracy.